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Targeted Assessment · Pre-Surgical Optimisation

Prepare Your Biology
Before the Operating Table

The surgeon's skill determines what is possible. Your nutritional status determines what is achieved. Ferritin, zinc, vitamin C, vitamin D, protein adequacy, and inflammatory load all substantially determine surgical outcomes — and none are assessed in the standard NHS pre-operative pathway.

6–8 weeksOptimisation window before surgery
Blood draw requiredVia Nordic Labs or Randox
Written reportWith protocol and supplement plan
Stephen DuncanFDN-P MSc BSc · 37 years clinical practice
Who this is for

Any elective procedure benefits from nutritional preparation

The wound healing cascade — the biological process by which your body repairs itself after any surgical intervention — has specific nutritional dependencies at every phase. Haemostasis requires vitamin K and zinc. The inflammatory phase requires vitamin C and zinc for immune cell function. The proliferative phase where collagen is laid down requires vitamin C, zinc, copper, iron, glycine, and adequate dietary protein. The remodelling phase requires ongoing nutritional support for months after the procedure.

None of this is assessed in the standard pre-operative pathway. You receive a cardiovascular fitness assessment, medication review, and consent for the procedure. What you don't receive is a nutritional assessment of the biological substrate on which the surgery will be performed.

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Hip & Knee Replacement
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ACL & Tendon Repair
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Cardiac Surgery
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Dental Implants
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Abdominal Surgery
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Aesthetic Procedures
What we assess

The markers the pre-operative pathway misses

Ferritin (not just haemoglobin)
Iron is required for prolyl hydroxylase — the enzyme that builds the collagen triple helix — alongside vitamin C. Low ferritin impairs collagen synthesis and oxygen delivery to healing tissue before anaemia is detectable.
NHS checks haemoglobin. Ferritin of 14 µg/L is "normal" — and clinically inadequate for healing.
Zinc
Required for immune cell function in the inflammatory phase, for matrix metalloproteinases in collagen remodelling, and for epithelial regeneration. Zinc deficiency is the most consistently documented nutritional deficiency affecting surgical outcomes.
Extremely common in the UK. Serum zinc is insensitive — functional deficiency is underdetected.
Vitamin C
Rate-limiting cofactor for prolyl hydroxylase. Without adequate vitamin C, collagen cannot form its characteristic triple helix structure. Surgical wounds in vitamin C-insufficient individuals heal more slowly and are more prone to dehiscence.
Requirements increase dramatically post-operatively. Standard dietary intake is insufficient in the peri-operative period.
Vitamin D
Regulates osteoblast activity (bone healing), modulates the immune response to surgical bacterial exposure, and reduces post-operative infection risk. Deficiency associated with significantly higher complication rates.
Endemic in Scotland. NHS threshold of 50 nmol/L is insufficient — functional target is 100–150 nmol/L.
CRP (Inflammatory Load)
Elevated pre-operative CRP is an independent predictor of surgical complications and extended hospital stay. Systemic inflammation dysregulates the wound healing cascade — extending recovery and increasing infection risk.
Not routinely checked in pre-operative assessment. Takes 30 seconds and costs £2 to add.
Protein Adequacy
Collagen, immune cells, and all repair enzymes are protein. Post-operative protein requirements rise to 1.5–2g per kg body weight daily. Most patients enter surgery eating inadequate protein and hospital food compounds the deficit.
Particularly relevant in older patients, those on calorie-restricted diets, and plant-based eaters.
Service · Pre-Surgical Optimisation
DH Pre-Surgical Assessment
Blood chemistry covering surgical recovery markers · Written clinical report · Supplement and nutrition protocol · Post-operative support plan
What's included
Blood chemistry panel — ferritin, zinc, vitamin C functional markers, vitamin D, CRP, albumin (protein status), full blood count
Dietary protein assessment — adequacy for peri-operative demands
Inflammatory load assessment — CRP plus gut health indicators where relevant
Written clinical interpretation report
Targeted supplement protocol for the 6–8 week pre-operative window
Post-operative nutritional support plan continuing through rehabilitation
What you'll know
Whether your nutritional status is adequate for optimal surgical healing
Specific deficiencies that could impair your recovery if uncorrected
Your inflammatory baseline and whether it needs addressing before surgery
Exactly what to take, when, and at what dose in the weeks before your procedure
How to support the remodelling phase through rehabilitation
Assessment fee
£345
Includes blood panel, written report, and protocol. Lab costs additional.
Book a Discovery Call →
Timing

Book at least 8 weeks before your procedure date to allow time for blood draw, results, protocol implementation, and meaningful nutritional correction before surgery. 12 weeks is ideal for procedures where vitamin D optimisation is a priority.

For sports injuries already sustained, the same assessment applies to rehabilitation — the wound healing biology is identical regardless of whether the injury is surgical or traumatic.

Further reading

The clinical evidence behind this service

Clinical Essay
What Your Surgeon Isn't Checking Before Your Operation
Clinical Essay
What Your Dentist Isn't Checking Before Your Implant
Test
Blood Chemistry — The Markers That Matter
The Gap Series
Normal Is Not the Same as Optimal

Not sure if you need this?

Talk to the Clinical Concierge first

Describe your procedure and current health picture — the concierge can help clarify what assessment would be most useful and whether the timing works.

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